Movement taking step back.(letters)(Letter to the Editor)

It is time someone called this whole anti-episiotomy movement into question.

As an ob.gyn. who has done literally thousands of episiotomies over 33 years, I must strenuously dispute Dr. Jay Goldberg's assertion that the episiotomy rate should be reduced and that rectovaginal fistulas and fecal incontinence are common complications ("Justification and Education Lower Episiotomy Rates," Dec. 15, 2003, p. 12).

I have seen exactly one rectovaginal fistula and essentially no incontinence problems that lasted beyond the first few weeks. Where are all these dreadfully injured women? Not only have I not seen them, I know no other obstetrician with my years of experience who has either.

The episiotomy was designed to reduce trauma to baby and mother and, done and repaired correctly, does just that. The numerous studies that claim to demonstrate the horrific nature of this procedure have many flaws, the biggest of which is the failure to take into account how the second stage of labor is being managed.

When prolonged strenuous pushing has left the vulva dramatically edematous, one can expect that expulsion of the baby will cause serious laceration, especially when no attention is paid to working toward a gradual and gentle emergence of the baby. If a mother stops pushing and simply "breathes" the baby out, which is not at all difficult to do when good anesthesia is used, there will rarely be a third-or fourth-degree extension.

The current forceps phobia is based largely upon the same misconceptions. The American College of Obstetricians and Gynecologists' guideline, which calls for a 3-hour second stage before using forceps, is, essentially, a guarantee of trauma. As ...